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The imbalance of power in mental health

A few weeks ago a discussion started on a friend’s status update about the stupid things that crisis line workers had suggested when we were in crisis. It was the catalyst for a rant to Paul about the unfairness of relying on other people to help you when you were feeling vulnerable. It spilled into conversations with my psychologist about how I now use having to deal with crisis lines as a deterrent for self harm.It was through these conversations that it hit me just how unbalanced the power is when it comes to a person with a mental illness. This imbalance spills into other parts of their life as well. Their physical needs are often written off as symptoms of a mental illness. Chest pain is a panic attack, stomach pain is anxiety, an allergic reaction is depression (this one happened to someone I know!).

Recently a friend was a passenger in a taxi when it was rear ended. When she presented to hospital she was asked all of the usual questions when being triaged. This friend has visible scars on her forearms, but did not mention her mental health history (it had been 4.5 years since she had been a patient at this hospital) as she felt it wasn’t relevant. Her mental health history wasn’t discussed during the consultation.

When my friend was discharged from the Emergency Department she received a summary of the treatment received while at the hospital. This summary also listed a mental illness under conditions she is diagnosed with. She hasn’t met the criteria for that diagnosis for 3 years and this mental illness wasn’t discussed during her consultation. Yet experience has taught me that if she had made a complaint about this, it wouldn’t have been taken seriously.

When I was unwell and living mostly in crisis mode, I would use the crisis team regularly. I received a myriad of responses over the years. I was told to bake muffins when suicidal, asked, with exasperation, what I expected them to do, told to self harm and just get it over with. Presentations to Emergency were written off as social calls, excuses to spend time with people and painful reflux (undiagnosed at the time) written off as attention seeking behaviour.

In all of these interactions I was not considered an equal. My opinions about my treatment were not considered. I was written off because people with a mental illness couldn’t be physically unwell too. If someone with no mental health history presents to Emergency with a broken leg, their motives are not questioned. Their treatment is rarely hindered by more than a busy, overworked department.

I’m not asking for miracles. I know that the reality of the world we live in means that there will always be an imbalance of power. However I do ask that those who are in positions of power, who deal with those with a mental illness, acknowledge that imbalance. I want them to acknowledge that the people they work with aren’t beneath them, that they are people beyond a mental health diagnosis. I want them to realise how much we lose when we open ourselves up and get hurt by the people who are supposed to help.

I’ve actually found the reverse. Taking a relative to psyches, they keep saying to her “So what do you think you should do?” and I keep wanting to yell at them “We don’t have medical degrees and we’re paying you a small fortune. I want to hear your opinion for that money! She knows what she thinks” I complained about this to someone once and they explained they were making her feel included…so I guess some people (me) like to be bossed around by Drs who know their stuff (I know for me, I need that with my GP, who once exasperatedly yelled at me “You’re not going to listen to me at all, are you?” (he was right) so he had to then give me advice that he said “If you must then blah blah blah BUT I absolutely advise against this, it’s a complete waste of time” (it was about the relative above and he was right, but I had to try). But I guess the KNOWING their stuff is the important part and weirdly, a lot of people attracted to that industry seem to be idiots.

I’m wondering if something else is at play when it comes to the hospital visit and by not making not of known previous conditions mental and otherwise and something goes wrong as a result they are somehow liable or will be accused of neglect?

I experienced something similar when admitted to hospital. I was accused of being an alcoholic because I continually presented with pancreatitis. Something that is generally attributed to alcoholics in someone my age. In my case it wasn’t.

They refused to take my word that I wasn’t a drinker (I’d been pregnant for 3 years in a row), so they called my hubby out of the room. Hubby stupidly made a joke about my “excessively” non-existent drinking habits which they took the wrong way before divulging the truth of the matter, that I just didn’t drink. Talk about give me a hard time. I’m sure the joke was recorded on file for each and every future visit and the real truth that I hadn’t had a drink in several years ignored.

That’s so wrong. I don’t know what the answer is except continued education for health workers who need it. I know they are busy and stressed but ignoring people is how mistakes are made. I’m super proud of my bestie, a nurse without a judgemental, presumptive bone in her body. If only we could clone her!

I think I used to do this a little with my husband. When we first were together I had never experienced depression and would label many things as that. I certainly learned quickly how wrong I was, something I am quite embarrassed about now.

I don’t think you need to be embarrassed when you genuinely didn’t know things. We aren’t born whit the knowledge of all the world and especially not all medical conditions. Importantly, you’ve learned 🙂

We had a negative experience with a hospital emergency department earlier this year when physical pain was written off as an anxiety attack. You know what makes people anxious? Not having their pain believed. Moronic healthcare system sometimes. And then guess what? It kept happening and was not deemed to be anxiety when a doctor bothered to listen.
Overall, it was a minor incident. As minor as emergency department trips are, I guess. But it made me concerned for people who present with mental health emergencies. It just left me so shocked as to how damaging it could be.
I’ve used a few counselling chat lines myself this year when I’ve been not coping with stress and while they haven’t been negative like the ones you descried, I would also classify 99% of what they said as useless. They kept confirming things to me that I had said. I didn’t want validation, I wanted ideas for help. It pissed me off and has put me off of asking for help in those areas.

You raise some hugely important issues and I do not really have any answers. I have experiences such as yours via my family’s health issues and for one specialist doctor who ‘got her diagnosis’ wrong for my hub we feel such resentment at her deficiency. She wrongly diagnosed early dementia and Parkinsons in my hub…(there is no specific test for PD) and…as it turned out. My hub had been chronically unwell for decades and under the care of one GP and a psychiatrist. Once my husband wrested control of his health back from a new GP and finally insisted on another opinion it was found that medications were giving the effects of memory loss etc. Long story short…YOU, the patient (hard word that!) need to be your best advocate and take back the power in the imbalance of the relationship. Best wishes to you because I think you are a wonderfully strong and resourceful woman. Denyse.

This reminds me of when, as a young teenager, I went to the phone box up the road and called Lifeline in desperation during one of my mother’s psychotic episodes. I was told that I was a naughty teenager and I should just go home and behave, and be nice to my mother. WTF! Another time, when I had severe PND (before it was diagnosed) I rang a crisis line after hubster and I had argued. He’d gone out despite my pleas otherwise as I knew I wasn’t coping. The “counsellor” on the end of the line, after hearing my tearful story, basically told me that all men are shits and what are we to do with them. It really shocked me – I mean it was okay for me to whinge about him but I really didn’t like it when she started dumping on him and men in general. Somehow I don’t think that’s what a phone counsellor is supposed to do …

I’ve been working in mental health reform for three years and I hope that things are changing, or that they will in the future. Culture change takes a long time to happen and there is a lot of money being invested in suicide prevention (ACTUAL MONEY) that will make a difference to both programs and staff training. There is a lot of research that shows that people suicide after seeing a health professional, not only a mental health one, so all emergency department workers should be screening for mental health as part of their core business. I’ve been a mental health social worker, a carer for my mum who has had ECT and chronic depression and sitting on the other side of the seat myself having a breakdown asking for help to have a doctor reply “you work in mental health, have you googled what you want me to prescribe” and another doctor told me she “didn’t have time” to write a mental health plan. I almost fell off the chair.